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ABSTRACT: To analyse the effect of surgical treatment of peri-implantitis without systemic antibiotics at different types of implants.
Four implants representing four different implant systems - turned (Biomet 3i), TiOblast (Astra Tech AB), SLA (Straumann AG) and TiUnite (Nobel Biocare AB) were placed in the left side of the mandible in six dogs, 3 months after tooth extraction. Experimental peri-implantitis was initiated by placement of ligatures and plaque formation. The ligatures were removed when about 40-50% of the supporting bone was lost. Four weeks later, surgical therapy including mechanical cleaning of implant surfaces was performed. No systemic antibiotics or local chemical antimicrobial therapy were used. After 5 months, block biopsies were obtained and prepared for histological analysis.
Two of the TiUnite implants were lost after surgical therapy. Radiographic bone gain occurred at implants with turned, TiOblast and SLA surfaces, while at TiUnite implants additional bone loss was found after treatment. Resolution of peri-implantitis was achieved in tissues surrounding implants with turned and TiOblast surfaces.
Resolution of peri-implantitis following treatment without systemic or local antimicrobial therapy is possible but the outcome of treatment is influenced by implant surface characteristics.
Journal Of Clinical Periodontology 01/2011; 38(1):58-64. · 3.00 Impact Factor
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ABSTRACT: The aim of the present study was to analyze tissue reactions to plaque formation following ligature removal in experimental peri-implantitis at commercially available implants in dogs.
Mandibular premolars and the three anterior premolars in both sides of the maxilla were extracted in six Labrador dogs. After 3 months, four implants representing four different implant systems--groups A (turned), B (TiOblast), C (SLA), D (TiUnite)--were placed in a randomized order in the right side of the mandible. Three months after implant installation, experimental peri-implantitis was initiated by placement of ligatures and plaque formation. The ligatures were removed when about 40-50% of the supporting bone was lost. After the subsequent 24-week period of continued plaque accumulation, block biopsies containing implants and their surrounding tissues were obtained and prepared for histological analysis.
All types of implants exhibited extensive inflammatory cell infiltrates and large associated crater-formed osseous defects. The lesions were consistently characterized by insufficient encapsulation of pus and biofilm layers and the inflammatory cell infiltrates extended apical of the pocket epithelium. The presence of numerous osteoclasts indicated active tissue destruction. The vertical dimension and the overall surface area of the infiltrated connective tissue (ICT) were larger at implants of group D than at other implant types.
It is suggested that spontaneous progression of peri-implantitis is associated with severe inflammation and tissue destruction.
Clinical Oral Implants Research 05/2009; 20(4):366-71. · 2.51 Impact Factor
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ABSTRACT: The aim of the present study was to analyze tissue reactions to plaque formation following ligature removal at commercially available implants exposed to experimental peri-implantitis.
Six Labrador dogs about 1 year old were used. All mandibular premolars and the three anterior premolars in both sides of the maxilla were extracted. After 3 months four implants representing four different implant systems with different surface characteristics--implant group A (turned), B (TiOblast), C (sandblasted acid-etched; SLA) and D (TiUnite)--were placed in a randomized order in the right side of the mandible. Three months after implant installation experimental peri-implantitis was initiated by placement of ligatures in a submarginal position and plaque accumulation. At week 12, when about 40-50% of the supporting bone was lost, the ligatures were removed. During the subsequent 24-week period plaque accumulation continued. Radiographic and clinical examinations were performed during the 'active breakdown' period (plaque accumulation and ligatures) and the plaque accumulation period after ligature removal. The experiment was terminated at week 36.
The bone loss that took place during the 'active breakdown' period varied between 3.5 and 4.6 mm. The additional bone loss that occurred during the plaque accumulation period after ligature removal was 1.84 (A), 1.72 (B), 1.55 (C) and 2.78 mm (D).
Spontaneous progression of experimentally induced peri-implantitis occurred at implants with different geometry and surface characteristics. Progression was most pronounced at implants of type D (TiUnite surface).
Clinical Oral Implants Research 11/2008; 19(10):997-1002. · 2.51 Impact Factor
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ABSTRACT: Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI® solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial “re-osseointegration” occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth surface (Turned) was minimal.RésuméLa paroïmplantite est une condition qui inclut l’inflammation du tissu mou et une perte osseuse rapide. Le traitement de la paroïmplantite inclut l’utilisation d’antimicrobiens et de méthodes d’augmentation osseuse. La question de savoir si une vraie ostéo’intégration peut se faire à la suite du traitement de la paroïmplantite est controversée. Le but de cette étude a été de vérifier si le caractère de la surface de l’implant était important pour une ré-ostéoïntégration à la suite du traitement de la paroïmplantite. Quatre chiens beagle ont été utilisés. Le prémolaires mandibulaires ont été avulsées. Après trois mois, trois implants dentaires vis solides ITI® ont été placés de chaque côté de la mandibule. Du côté gauche, des implants avec une surface usinée (T) ont été placés tandis que du côté droit, des implants (SLA). Après trois mois de guérison, la paroïmplantite a été induite par le placement de ligatures et l’accumulation favorisée de plaque dentaire. Quand environ 50% du support osseux initial avait été perdu, les ligatures ont été enlevées. Cinq semaines après, le traitement a débuté. Chaque animal a reçu des tablettes d’amoxicilline et de métronidazole durant 17 jours. Trois jours après le début de la prise des antibiotiques, un site implantaire expérimental de chaque quadrant a été traité localement. A la suite de l’élévalation d’un lambeau, la surface en titane exposée a été nettoyée à l’aide d’un coton imbibé d’eau physiologique. Les implants ont été enfouis et six mois plus tard des biopsies ont été prélevées. Le résultat du traitement était un comblement osseux de 72% des lésions osseuses au niveau T et de 76% au niveau SLA. Le pourcentage de ré-ostéoïntégration était de 26% au niveau T et de 84% au niveau SLA. Un traitement qui comprenait 1) l’administration systémique d’antibiotiques combiné avec 2) l’enlèvement du tissu de granulation et le nettoyage de la surface implantaire résultait en l’arrêt de la paroïmplantite et le comblement osseux des lésions osseuses adjacentes. De plus une ré-ostéoïntégration substantielle apparaîssait au niveau d’un implant avec une surface rugueuse (SLA), tandis que la croissance osseuse au niveau d’une surface lisse exposée (usinée) était minime.ZusammenfassungDie Periimplantitis ist ein Geschehen, welches sich in einer Entzündung der Weichgewebe und in rapidem Knochenverlust äussert. Die Therapie der Periimplantitis besteht sowohl aus antimikrobiellen als auch aus knochenaufbauenden Massnahmen. Die Frage, ob nach der Therapie der Periimplantitis eine wirkliche Re-Osseointegration zustande kommt, wird unterschiedlich beantwortet. Ziel: zu untersuchen, ob die Charakteristik der Implantatoberfläche für eine mögliche Re-Osseointergration nach der Therapie der Periimplantitis wichtig ist. Es wurden 4 Beagle-Hunde verwendet. Die Prämolaren im Unterkiefer wurden extrahiert. Nach 3 Monaten wurden auf jeder Seite des Unterkiefers 3 ITI® Vollschraubenimplantate eingesetzt. Auf der linken Seite wurden Implantate mit einer gedrehten Oberfläche (gedrehte Stellen) verwendet, während auf der rechten Seite Implantate mit einer SLA-Oberfläche (SLA Stellen) eingesetzt wurden. Nach einer Einheilzeit von 3 Monaten wurde mittels Ligaturen und Plaqueakkumulation eine Periimplantitis induziert. Nachdem etwa 50% des initialen Knochenniveaus verloren gegangen waren, wurden die Ligaturen entfernt. Fünf Wochen später wurde mit der Behandlung begonnen. Jedes Tier erhielt Amoxicillin und Metronidazol in Tablettenform für einen Zeitraum von 17 Tagen. Drei Tage nach dem Start der Antibiotikatherapie wurde eine Implantatstelle (experimentelle Stelle) in jedem Quadranten einer lokalen Therapie unterzogen. Nach dem Abheben eines Weichteillappens wurde die exponierte Implantatoberfläche mit einem in Kochsalzlösung getränkten Wattepellet gereinigt. Die Schleimhaut wurde über den Implantaten primär vernäht. Sechs Monate später wurden Biopsien gewonnen. Die Behandlung resultierte in einer knöchernen Auffüllung von 72% in den Knochendefekten bei den gedrehten Stellen und von 76% bei den SLA Stellen. Das Ausmass der Re-Osseointegration betrug bei den gedrehten Stellen 26% und bei den SLA Stellen 84%. Ein Behandlungsprotokoll, welches aus (i) der systemischen Verabreichung von Antibiotika in Kombination mit (ii) Granulationsgewebeentfernung und Reinigung der Implantatoberfläche besteht, resultierte in einem Verschwinden der Periimplantitis und in einer knöchernen Auffüllung der angrenzenden Knochendefekte. Während es bei den rauhen Implantatoberflächen (SLA) zu einer beträchtlichen “Re-Osseointegration” kam, war das Knochenwachstum bei zuvor exponierten glatten Oberflächen (gedreht) nur minimal.ResumenLa periimplantitis es una condición que incluye inflamación del tejido blando y rápida pérdida de hueso. El tratamiento de la periimplantitis incluye métodos antimicrobianos y de aumento de hueso. La cuestión de que pueda ocurrir una re-osteointegración verdadera tras el tratamiento de una periimplantitis esta controvertida. Objetivo: Estudiar si las características de la superficie del implante eran de importancia para que ocurriese una re-osteointegración tras el tratamiento de la periimplantitis. Se usaron cuatro perros Beagle. Se extrajeron los premolares mandibulars. Tres meses después se colocaron 3 implantes dentales macizos roscados ITI® en cada lado de la mandíbula. En el lado izquierdo se usaron implantes con una superficie pulida (lugar pulido) mientras que en el lado derecho se usaron con superficie SLA (lugar SLA). Después de tres meses de cicatrización se indujo una periimplantitis por colocación de ligaduras y acumulación de placa. Cuando se hubo perdido alrededor del 50% del soporte óseo inicial, se retiraron las ligaduras. Cinco semanas mas tarde se inició el tratamiento. Cada animal recibió tabletas de amoxicilina y metronidazol durante un periodo de 17 días. Después de tres días tras el comienzo del régimen antibiótico, un lugar implantario (lugar experimental) en cada cuadrante se expuso para tratamiento local. Después de la elevación de un colgajo se limpió la superficie expuesta de titanio con una bolita de algodón empapada en suero salino. Los implantes se sumergieron. Se obtuvieron biopsias seis meses mas tarde. El tratamiento resultó en un 72% de relleno de hueso de los defectos óseos en los lugares pulidos y de un 84% en los SLA. Un régimen de tratamiento que incluyó (i) administración de antibióticos combinado con (ii) retirada del tejido de granulación y limpieza de superficie del implante resultó en la resolución de la periimplantitis y el relleno de hueso en los defectos óseos adyacentes. Mas aun, mientras que una sustancial “re-osteointegración” ocurrió en un implante con superficie rugosa (SLA), el crecimiento de hueso en una superficie lisa previamente expuesta fue mínimo.
Clinical Oral Implants Research 07/2008; 12(6):595 - 603. · 2.51 Impact Factor
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ABSTRACT: To study the healing of marginal defects that occurred at implants placed in a healed ridge or in fresh extraction sockets.
Six dogs were used. The right side of the mandible was used in the first part of the study. The first, second premolars and first molars were extracted. After 3 months of healing the bone was prepared for implant installation in these premolar and molar sites. The marginal 5 mm of each recipient site was widened with a conical drill. Following implant installation a gap of varying dimension occurred around the titanium rod (artificial defect (A) sites). At this interval the third and fourth premolars were extracted and implants were installed in the distal socket of the two teeth (natural defect (N) sites). The flaps were sutured to allow non-submerged healing. After 2 months, the procedures were repeated in the left side. Two months later the animals were euthanized, and biopsies were obtained and prepared for histological examination.
The length of the zone of de novo'bone-to-implant contact' in the defect region was longer at the A sites than at the N sites both at the 2- and the 4-month interval. Further, while after 4 months of healing the marginal bone crest at the A sites was located close to the abutment/fixture junction, at the N sites a marked reduction of the height of the bone crest was documented. Hence, most A site defects became completely resolved whereas healing of the N site defects was incomplete.
The process of bone modeling and remodeling at an implant placed in a fresh extraction socket differs from the resolution of marginal defects that may occur following implant installation in a healed ridge.
Clinical Oral Implants Research 09/2006; 17(4):351-8. · 2.51 Impact Factor
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ABSTRACT: Marginal hard tissue defects present at implants with a rough surface can heal with a high degree of bone fill and osseointegration. The healing of similar defects adjacent to implants with a smooth surface appears to be less predictable.
The aim was to compare bone healing at implants with turned or rough surface topographies placed in self-contained defects using either a submerged or non-submerged installation technique.
Six dogs were used. Three months after tooth extraction four experimental sites were prepared for implant installation in both sides of the mandible. The marginal 5 mm of the canal prepared for the implant was widened. Thus, following implant placement a circumferential gap occurred between the bone tissue and the implant surface that was between 1 and 1.25 mm wide. In each side of the mandible two implants with a turned surface and two implants with a rough surface were installed. The implants in the right side were fully submerged, while a non-submerged technique was applied in the left side. The animals were sacrificed 4 months later, block biopsies of each implant site were dissected and ground as well as paraffin sections were prepared.
The marginal defects around rough surface implants exhibited after 4 months of healing substantial bone fill and a high degree of osseointegration following either the submerged or the non-submerged installation technique. Healing at turned implants was characterized by incomplete bone fill and the presence of a connective tissue zone between the implant and the newly formed bone. The distance between the implant margin (M) and the most coronal level of bone-to-implant contact (B) at implants with a rough surface was 0.84+/-0.37 mm at submerged and 0.90+/-0.39 mm at non-submerged sites. The distance M-B at implants with a turned surface was 3.39+/-0.52 mm at submerged and 3.23+/-0.68 mm at non-submerged sites. The differences between the rough and turned implants regarding the length of distance M-B were statistically significant (paired t-test).
Osseointegration at implants placed in sites with marginal defects is influenced by the surface characteristics of the implant.
Journal Of Clinical Periodontology 06/2005; 32(5):448-55. · 3.00 Impact Factor
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ABSTRACT: Histologic studies have demonstrated the possibility to reestablish direct bone-implant contacts after ligature-induced periimplantitis. The influence of the reosseointegration on the stability of implants is not known.
The aim of the present investigation was to study bone tissue and associated implant stability alterations that occurred during induction and resolution of periimplantitis using resonance frequency analysis (RFA), radiography, and histology.
Three implants with smooth (turned) or roughened (SLA) surfaces were placed in each side of the edentulous mandible of four dogs. Experimental periimplantitis was induced for 3 months. Five weeks later, the animals were treated with antibiotics and surgical therapy and were followed for another 6 months. Periapical radiographs and RFA were used to evaluate marginal bone levels and implant stability throughout the study period. After termination, the tissue-implant interface was evaluated by light microscopy in ground sections.
There was a linear relationship between radiographic and RFA findings because continuous loss of marginal bone and a decrease in implant stability were observed for both implant surfaces during the periimplantitis period. Antibiotic treatment and surgical therapy resulted in some reosseointegration, which was more marked for the SLA surface. The resonance frequency values corresponded well to the histometric measurements because reosseointegration resulted in an increase in implant stability.
The findings from the present study indicate a linear relationship between marginal bone level and resonance frequency value. It is suggested that the RFA technique is sensitive and may be used to detect even a minor change in the level of bone-implant contact.
Clinical Implant Dentistry and Related Research 02/2005; 7(3):136-40. · 3.53 Impact Factor
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ABSTRACT: Various methods have been applied for the treatment of periimplantitis lesions. It has been reported that the procedures used have been effective in eliminating the inflammatory lesion but that re-osseointegration to the once-contaminated implant surface has been difficult or impossible to achieve.
The aim of this study was to examine the use of carbon dioxide (CO2) laser in combination with hydrogen peroxide in the treatment of experimentally induced periimplantitis lesions.
Three dental implants (ITI Dental Implant System, Straumann AG, Waldenburg, Switzerland) were placed in each side of the edentulous mandible of four beagle dogs. Implants with a turned surface and implants with a sand-blasted large-grit acid-etched (SLA) surface (SLA, Straumann AG, Waldenburg, Switzerland) were used. Experimental periimplantitis was induced during 3 months. Five weeks later each animal received tablets of amoxicillin and metronidazole for a period of 17 days. Three days after the start of the antibiotic treatment, full-thickness flaps were elevated, and the granulation tissue in the bone craters was removed. In the two anterior implant sites in both sides of the mandible, a combination of CO2 laser therapy and application of a water solution of hydrogen peroxide was used. The implant in the posterior site of each quadrant was cleaned with cotton pellets soaked in saline. Biopsy specimens were obtained 6 months later.
The amount of re-osseointegration was 21% and 82% at laser-treated turned-surface implants and SLA implants, respectively, and 22% and 84% at saline-treated turned-surface implants and SLA implants, respectively.
The present study demonstrated the following: (1) a combination of systemic antibiotics and local curettage and debridement resulted in the resolution of experimentally induced periimplantitis lesions; (2) at implants with a turned surface, a small amount of re-osseointegration was observed at the base of the bone defects whereas a considerable amount of re-osseointegration occurred at implants with an SLA surface; and (3) the use of CO2 laser and hydrogen peroxide during surgical therapy had no apparent effect on bone formation and re-osseointegration.
Clinical Implant Dentistry and Related Research 02/2004; 6(4):230-8. · 3.53 Impact Factor
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ABSTRACT: The aim of the present experiment was i) to study the effect of anti-microbial therapy of experimentally induced peri-implantitis lesions and ii) to assess features of bone regrowth following treatment. Four beagle dogs were used. Three titanium fixtures (Brånemark System®) were installed in each quadrant of the mandible (premolars previously extracted). Abutment connection was performed 5 months later and ligature induced break-down was initiated. The ligatures were removed when approximately 50% of the initial bone support was lost. A 3-week antibiotic regimen (amoxi-cillin and metronidazole) was initiated 1 month later. Two days after the start of the antibiotic administration, the experimental implant sites were exposed to local therapy. The abutments were removed and the exposed fixture surfaces were treated with an abrasive (pumice) administered via a rotating brush (left side) or cleaned with cotton pellets soaked in saline (right side). Cover screws were attached to the fixtures and the implants were submerged. Fluorochromes were injected intravenously 2 weeks, 4 weeks and 12 weeks after surgery. The animals were killed 7-months after surgery and block biopsies of each implant site were dissected and prepared for histological analysis. The findings of the examinations disclosed that the inflammatory lesion was resolved and new bone formation had occurred in the previous defect following antimicrobial and local therapy. The amount of “re-osseointegration” that had taken place, however, was small. Indeed, at all experimental implant sites, a thin connective tissue capsule was found to separate the implant surface from the newly formed bone.
Clinical Oral Implants Research 05/1999; 10(3):195 - 203. · 2.51 Impact Factor
